Tuesday, December 31, 2019

Using Attachment, Regulation, and Competency Modality with Foster Children

This is a summary/review of an assignment I did last semester.

Background:  This year I am doing my internship with an agency that contracts with DCFS to provide Mental Health Assessments and Individual and Family Therapy to children and adolescents who are currently in the foster care system or who have been adopted (in many instances) from foster care. 

Employees at my work are required to read the book Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience and through Attachment, Self-Regulation, and Competency written by two clinicians, Margaret Blaustein and Kristine Kinniburgh.  Blaustein and Kinniburgh are a clinical psychologist and a clinical social worker who both specialize in treating complex childhood trauma and/or in incorporating trauma-informed practices into a range of settings.  These two women were influenced by the work of Dr. Bessell Van der Kolk, among other clinicians, who work with clients impacted by trauma and they have developed a specific treatment framework called the ARC Modality which is used to treat developmental trauma and accompanying problems in youth.   

Before I explain the ARC Modality, I will summarize what Treating Traumatic Stress in Children and Adolescents teaches about developmental trauma and how that fits into my internship:  The population that I work with would never have come into state custody in the first place if they hadn’t suffered from abuse, neglect, or abandonment.  Although the symptoms and diagnoses of my clients vary, all of these children are suffering in some degree from the affects of developmental trauma which can be defined as chronic trauma caused by a child’s caregivers early in life which greatly affects, among other areas, their ability to form safe and healthy attachments with others.  There are many other traumas such as a car accident, natural disaster, or sexual assault which can result in the victim developing acute stress disorder, adjustment disorder, or PTSD.  The difference between a traumatic event such as a car accident or fire, for example, versus parental neglect and child abuse is that they are not usually caused by an individual’s caretaker who has the responsibility to care for them so the child’s ability to trust and form safe and healthy attachments is greatly impacted, sometimes resulting in attachment disorders such as Reactive Attachment Disorder or Disinhibited Social Engagement Disorder.  Many children suffering from early trauma at the hands of their caregivers also have trouble regulating their emotions since so much of their energy and brain is stuck in “fight, flight, or freeze” mode or they are triggered easily.

ARC stands for Attachment,Regulation, and Competency which are the three different domains of their treatment.  When I develop treatment plans and therapy goals with my clients at work I am required to use the ARC Modality.  

 Attachment refers to being able to connect with people in a safe way which is hard for a lot of kids if they never had the opportunity for their parents or first families to meet their needs and model what a healthy, nurturing parent-child securely attached relationship looks like for them.  Regulation simply refers to not only being able to identify emotions in oneself and others but being able to express those emotions in healthy ways (not kicking or hitting other people when you’re angry, etc).  or, on the other extreme, not ignoring or dissociating from unpleasant emotions and sensations.  Competency refers to being able to function executively and follow through with basic tasks of everyday living. 

The majority of my sessions with clients focus on the simple goal of affect identification and regulation- or simply put, being aware of one’s emotions and keeping them in check.  This book not only gives an overview of attachment theory and developmental trauma, but also contains some assessment questions and suggested interventions for treating each of the domains in the ARC Modality- Attachment, Regulation, and Competency.  It’s been especially helpful to get ideas for interventions for attachment because I’ve recently started doing family therapy with a few clients either between parent and child or siblings together and attachment is almost always primarily what we work on in those sessions.  In addition, some of the attachment interventions are ones I can use to increase attunement with my own children in my own home.

If you currently work with or have an interest in working with clients or families who have suffered attachment injuries or developmental trauma I recommend reading the book Treating Traumatic Stress in Children and Adolescents.

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